ORDER ON MOTIONS
THIS MATTER comes before the Court on Motion for Partial Summary Judgment by Plaintiff (Dkt. # 142), Motion for Summary Judgment by Defendants (Dkt. # 145), and Motion for Reconsideration by Plaintiff (Dkt. # 197). On February 14, 2014, the Court denied Plaintiffs claim to exclude her group disability insurance application from evidence and deferred the parties’ breach of contract and rescission claims pending supplemental briefing on the application of Virginia law. Having considered the parties’ supplemental briefs, oral argument, the remainder of the record, and applicable case law, and for the reasons that follow, the Court hereby denies Plaintiffs Motion for Reconsideration and denies summary judgment on the remaining issues pending before it.
Background
This matter arises out of the decision of Defendants American General Life Company (“American General”) and The United States Life Insurance Company (“US Life”) to rescind the long term disability coverage of Plaintiff Christyanna Karpenski due to alleged misrepresentations made by her on her Disability Insurance Application (“Application”). A complete factual account of this matter is presented in the Court’s Order of February 14, 2014, denying in part Plaintiffs Motion for Partial Summary Judgment. See Dkt. # 192, pp. 1-5. The Court therein determined that the choice-of-law provision in the American Physical Therapy Association (“APTA”) Master Policy, under which Plaintiff procured coverage, selecting Virginia law as the governing law was valid and enforceable. The Court also denied Plaintiffs claim to preclude Defendants from introducing her Application into evidence because of Defendant U.S. Life’s failure to attach it to her Certificate of Insurance in her Welcome Packet.
As the parties had only briefed the application of Virginia law to the attachment claim raised by Plaintiffs partial summary judgment motion, the Court directed the parties to file further supplemental briefs on the application of Virginia law to the remaining contractual claims for rescission, violation of the Application’s good health provision, and breach of contract. Id. at pp. 25-26. In denying Plaintiffs subsequent motion to stay briefing pending a motion for reconsideration, the Court clarified its previous Order by permitting the parties to additionally address whether Virginia and Washington law conflict with regards to the remaining claims. See Dkt. # 194, p. 2. Remaining before the Court are Plaintiffs claims in its Motion for Par
On February 28, 2014, Plaintiff filed a Motion for Reconsideration, moving the Court to reconsider its Order of February 14, 2014 based on its application of Virginia law to the contractual claims presented in this case. Specifically, Plaintiff contends that: (1) the Court already ruled that Washington rescission law is the law of the case, (2) it is manifest error to apply Virginia law to any or all claims, and (3) the Court manifestly erred in not ruling on the applicability of RCW 48.18.080. This Order considers Plaintiffs Motion for Reconsideration, the remaining issues raised in the parties’ motions for summary judgment, and Plaintiffs Motion to Strike evidence introduced by Defendants in their supplemental brief (Dkt. # 201).
Analysis
a) Motion for Reconsideration
Motions for reconsideration are disfavored and will be denied “in the absence of a showing of manifest error in the prior ruling or a showing of new facts or legal authority which could not have been brought to [the Court’s] attention earlier with reasonable diligence.” Local Rule CR 7(h)(1). Where summary judgment has been entered, “ ‘after thoughts’ or ‘shifting of ground’ are not an appropriate basis for reconsideration.” Fay Corp. v. BAT Holdings I, Inc.,
Because the Court fails to identify any manifest error in its Order, the Court denies Plaintiffs Motion for Reconsideration. First, Plaintiff contradicts herself in arguing that the Court erred in addressing the applicability of Virginia law as it previously applied Washington law in its Order on bifurcation (Dkt. #41). As Plaintiff herself points out, Washington follows the rule of depecage, whereby “different issues in a single case arising out of a common nucleus of facts may be decided according to the substantive law of different states.” FutureSelect Portfolio Mgmt., Inc. v. Tremont Group Holdings, Inc.,
Plaintiff further argues that the Court erred by misclassifying Plaintiff’s insurance as “true group insurance.” Despite characterizing her insurance policy as “group insurance” throughout litigation, Plaintiff now for the first time attempts to characterize it as a “franchise policy.” Relying on dicta in Erickson v. Sentry Life Ins. Co.,
As to the additional contractual claims before the Court, the Court hereby clarifies that it proceeds under Washington choice-of-law analysis in making a separate determination of the applicable law governing each claim. The Court’s solicitation of supplemental briefing by the parties on the results under Virginia law was necessary to make a proper choice-of-law determination. As the parties had neglected to brief the results of rescission, breach of contract, and good health provision claims under Virginia law, the Court was not previously in a position to make the required determination as to whether an actual conflict existed between the local law of Washington and the contractually chosen Virginia law. See Seizer,
Finally, Plaintiffs position that the Court erred in not ruling on whether RCW 48.18.080 governs her attachment claim is clearly incorrect. The Court directly addressed the applicability of RCW 48.18.080 in its Order and adopted a position that Plaintiff herself had put forward in determining that RCW 48.21.060 governs attachment for group disability applications. See Dkt. # 192 at pp. 18-19; Dkt. # 190 (“RCW 48.21.060 governs that [sic] admissibility of an insurance application for group disability insurance.”). Plaintiff has failed to identify any manifest error in the Court’s decision that RCW 48.21.060, rather than RCW 48.18.080, governed her attachment claim under Washington law.
b) Motion to Strike
In reply (Dkt. # 201), Plaintiff moves the Court to strike new evidence attached to and discussed in Defendants’
There is no dispute that Defendants neither produced the contested evidence through their initial disclosures, timely supplements, or in response to Fed. R.Civ.P. 34 document requests by Plaintiff. Rather, Defendants waited until after the discovery deadline and relevant dispositive motions deadline were past and dispositive briefs were filed to include the material for the first time with a Court-ordered supplemental brief. See Scheduling Order, Dkt. # 72. To permit consideration of the evidence at this stage in summary judgment would unfairly prejudice Plaintiff, who has fully briefed both pending dispositive motions and lacks any opportunity to respond to Defendants’ late-submitted evidence pri- or to the Court’s ruling. Given the completion of briefing, Defendants’ multiple supplements to Rule 26(a) disclosures and in response to Rule 34 discovery requests in which this disclosure was not included, and as the evidence is outside the ambit of the Court’s Order requesting supplemental briefing on Virginia law, the untimely disclosure cannot be substantially justified or harmless with respect to the pending summary judgment motions. See National Union Fire Ins. Co. v. Greenwich Ins. Co.,
c) Summary Judgment Standard
Summary judgment shall be granted where “the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). Anderson v. Liberty Lobby, Inc.,
d) Rescission
Defendants move for summary judgment on the rescission counterclaim and affirmative defense on the grounds that Plaintiff made material misrepresentations on her Disability Insurance Application. Plaintiff also moves for summary judgment on rescission on the grounds that intent to deceive is a necessary element of rescission under Washington law and that Defendants had no evidence of intent to deceive when they determined to rescind Plaintiffs policy. The parties dispute whether Virginia or Washington law governs Defendants’ rescission counterclaim.
1) Choice of Law
As an initial matter, the Court must determine the state law applicable to this claim. This Court, sitting in diversity, applies the choice-of-law rules of Washington. See Downing v. Abercrombie & Fitch,
If an actual conflict exists and the parties selected the governing law, Washington courts apply section 187 of the Restatement (Second) Conflict of Laws (1971) to determine whether the parties’ contractual choice-of-law provision is effective. Courts in Washington generally enforce choice-of-law provisions in contracts. Schnall v. AT & T Wireless Services, Inc.,
With regards to Defendants’ rescission counterclaim, the choice-of-law inquiry at this stage of the pleadings stops at the threshold because no real conflict results under Virginia and Washington
No statement in an application or in any affidavit made before or after loss under the policy shall bar a recovery under a policy of insurance unless it is clearly provided that such answer or statement was material to the risk when assumed and was untrue.
Thus under Virginia law, an insurer seeking to rescind a contract must establish two elements by clear proof: (1) that the insured’s representation was false, and (2) that the false representation was material to the insured’s determination to undertake the risk and issue the policy. Banner Life Ins. Co. v. Noel,
Rescission under Washington law is governed by RCW 48.18.090. The statute contains two subsections, the first pertaining to “oral and written misrepresentation^] ... made in the negotiation of an insurance contract,” and the second to statements made in writing by the insured in an application for life or disability insurance. See RCW 48.18.090. Where the first or both sections are implicated, Washington law clearly requires that an insured may rescind a policy upon satisfying four factors: (1) the policyholder represented as truthful certain information during the negotiation of the insurance contract; (2) those representations were untruthful, or misrepresentations; (3) the misrepresentations were material; and (4) the misrepresentations were made with the intent to deceive. See Cutter & Buck, Inc. v. Genesis Ins. Co.,
However, where only RCW 48.18.090(2) is implicated, “ ‘actual intent to deceive’ does not necessarily need to be established in order to rescind the insurance agreement.” Northwestern Mut. Life. Ins. Co. v. Koch,
In any application for life or disability insurance made in writing by the insured, all statements therein made by the insured shall, in the absence of fraud, be deemed representations and not warranties. The falsity of any such statement shall not bar the right to recovery under the contract unless such false statement was made with actual intent to deceive or unless it materially affected either the acceptance of the risk or the hazard assumed by the insurer.
(emphasis added). Rescission under subsection (2) requires first that a false statement be knowingly made on the part of the insured. Northwestern Mut. Life. Ins. Co. v. Koch,
Proof that a material false statement was made knowingly raises the presumption that it was made with intent to deceive. See Music v. United Ins. Co. of Am.,
As U.S. Life’s decision to insure Plaintiff was based solely on her written application, rescission in the instant case is governed under RCW 48.18.090(2). No oral or written negotiations took place that would trigger the additional requirements of RCW 48.18.090(1), and indeed could not have as Plaintiff received standardized insurance under APTA’s group disability Master Policy. Thus under Washington law, as under Virginia law, intent to deceive is not a necessary element of rescission, which can also be effected upon a showing of a knowing and material misrepresentation. As the parties have not shown that application of Washington and Virginia law would lead to a different outcome on rescission at this juncture, the Court applies Washington law to Defendants’ rescission counterclaim for the purpose of the pending summary judgment motions.
2) Scope of Misrepresentations
The parties dispute to what extent Plaintiff misrepresented information on her Disability Application. Defendants contend that Plaintiff made wide-ranging misrepresentations in response to questions 2 and 3 of her Application, including through her failures to disclose neck and back pain, menstrual disorder, recurrent headaches, chronic fatigue, thyroid disorder, mental or emotional problems, and treatment and consultations with various physicians and clinics. Defendants also contend that Plaintiff misrepresented her polyp treatment on the Application and in response to a follow-up questionnaire. In response, Plaintiff contests that any misrepresentations were made and further moves the Court to preclude Defendants from invoking any allegations other than nondisclosure of joint and musculoskeletal disorders, which were the sole grounds for voiding coverage provided by American Life in its letter rescinding coverage. See Dkt. # 144, Ex. N (notifying Plaintiff that U.S. Life was rescinding coverage on the basis of Plaintiffs omitted history of joint and musculoskeletal disorders, including
Both Washington and Virginia recognize a common law doctrine known as “mend the hold,” which precludes an insurer from changing the basis for avoiding liability after the onset of litigation. See, e.g., White v. Bott,
Where a party gives a reason for his conduct and decision touching any thing involved in a controversy, he cannot, after litigation has begun, change his ground, and put his conduct upon another and a different consideration. He is not permitted thus to mend his hold. He is estopped from doing it by a settled principle of law.
Under Washington law, the mend the hold doctrine may be invoked to preclude insurers from introducing new or changed bases for denying insurance coverage once litigation has begun. See Ledcor Industries (USA) Inc. v. Virginia Sur. Co., Inc.,
Application of the factors for mend the hold estoppel precludes Defendants from changing their grounds for rescission from those that they stood on prior to the onset of litigation. American General investigated Plaintiffs claim for benefits from as early as June 2009 until issuing the denial letter nearly a year later. American General’s contestable review took place over a span of at least six months, from the point that it received Plaintiffs Disability Claim Questionnaire about her medical and treatment history in November 2009. See Dkt. # 144, Ex. G. As required under Washington law, American General then provided a reasoned explanation for denying Plaintiffs claim and rescinding her policy in its formal denial letter issued on May 11, 2010. See WAC 284-30-330(13) (requiring insurer to “provide a reasonable explanation of the basis in the insurance policy in relation to the facts or applicable law for denial of a claim.”); ROW 48.30.015(5)(a). Had there
The Court disagrees with Defendants that their reservation of rights in their declination letter was sufficient to preserve additional bases for rescission. Such a stance is contrary to Washington statutory law, WAC 284-30-330(13), and has never been acknowledged by either Washington or Virginia courts as a means to overcome estoppel. Cf. In re Aberdeen 100, Inc.,
Accordingly, the Court considers first whether Plaintiff knowingly misrepresented her history of joint and musculoskeletal disorders on her Application. Defendants contend that Plaintiff knowingly misrepresented this history when she answered “No” under Question 2(b) of her Application. Question 2(b) asked, “Have you ever had or been treated for ... injury, pain or disorder of the neck or back? Sciatica? Any disabling injury?” As evidence of misrepresentation, Defendants point to numerous admissions regarding a history of neck and back pain and related physical therapy that Plaintiff made in her deposition. When questioned whether she knew when she filled out her Disability Application in February 2009 that she had experienced muscular back pain, she responded, “I knew that I had experienced at some point some muscular back pain, yes.” Dkt. # 150, Ex. 1, pp. 139. Plaintiff further admitted that she underwent 25 physical therapy sessions from November 13, 2007 to July 30, 2008, for which she billed her health insurer. Id. at pp. 139, 163. Plaintiff admitted to disclosing a history of back pain to her physical therapist, Caryn Pierce, in November 2007, though she contested that the pain was the subject of her visit. Id. at p. 56. In her deposition, Pierce corroborated that Plaintiff had been experiencing back pain and occasional neck pain at this time, including while treating her patients. Id. at Ex. 4, pp. 69, 79. Pierce explained that Plaintiff herself discovered in a techniques class that she was suffering “symptoms of a somatic dysfunction, which is localized point tenderness and active tension held ... in the muscles even when she was at rest and that it prevented full mobility.” Id. at p. 72.
Defendants further point to Plaintiffs clinical reports of neck and back pain and disorder. Plaintiff, for instance, checked “yes” to experience of “back pain” since her previous visit on a Return Patient Form when visiting her doctor on February 13, 2007. Id. at Ex. 3. In February 2008, Plaintiff began seeing physical therapist Fawn Coussens for low back pain, which she indicated on an Initial Evaluation Intake Form that she was experiencing more than four times a day and which was severe enough to awaken her at night. Id. at Ex. 6, p. 44 (Plaintiff “was complaining of low back pain” when she presented for physical therapy on February 6, 2008); Ex. 8. Plaintiff continued to treat for back pain with Ms. Coussens through spring of 2008. See Id. at Ex. 6, p. 95. Plaintiff
As an initial matter, the Court finds that Plaintiff averred to the truthfulness of the statements in her Application. Her Application contained the following clause:
“To the best of my knowledge and belief, all statements I made above are true and complete. I understand that my application for group insurance will be accepted or declined on the basis of these statements.”
Plaintiff’s signature on the Application several lines below this clause satisfies the first Cutter & Buck factor. See Cutter & Buck,
3) Intent to Deceive
Whether a misrepresentation is made with intent to deceive is a question of fact. Wilburn v. Pioneer Mutual Life Ins. Co.,
As discussed supra, Defendants have introduced clear, convincing, and credible evidence to establish that Plaintiff knowingly misrepresented her history of neck and back pain or disorder. Plaintiff contends that the ensuing presumption disappears in light of evidence of her innocent intent or honest motive. As evidence of her innocent intent, Plaintiff contends that: (1) she did not seek out disability insurance from U.S. Life, (2) she did not apply for the maximum allowable benefits, (3) she freely signed all authorizations for release of information, (4) she fully cooperated during the claim investigation, (5) she openly informed American General of her physical
Viewing the evidence in the light most favorable to the non-moving party, Plaintiff has introduced sufficient evidence of innocent intent such that a jury should determine this prong as a question of fact. The presumption of intent to deceive is not itself evidence but merely a presumption that shifts the burden of producing prima facie evidence of innocent intent to Plaintiff. See Kay,
Plaintiff also argues that Defendants should be precluded from arguing intent to deceive as they failed to specifically raise Plaintiffs intent as grounds for rescission prior to litigation. See Dkt. # 142, pp. 12-13. The Court disagrees. Plaintiff has not pointed to any case in which a Washington court required an insurance company to specifically cite to “intent to deceive” in its denial letter. The Court finds that Defendants sufficiently notified Plaintiff that they would argue this element when they informed her that they were rescinding her Application due to misrepresented history of joint and musculoskeletal disorders. Plaintiff consequently was not prejudiced by Defendants’ failure to specifically assert her intent to deceive. As it finds that Defendants are not estopped from asserting intent to deceive as grounds for rescinding coverage, the Court also denies Plaintiffs’ Motion for Partial Summary Judgment on this prong.
4) Materiality
As discussed supra, Defendants may still rescind Plaintiffs coverage if they can establish through clear, cogent, and convincing evidence that Plaintiffs misrepresentations were material. Queen City Farms v. Cent. Nat’l Ins. Co. of Omaha,
The materiality of a misrepresentation is typically a question of fact. Cutter & Buck,
Defendants’ reliance on Cutter & Buck is misplaced. The Cutter & Buck court was interpreting a decision by a Washington Court of Appeals, which found that “when an insurer asks no information in regard to a certain matter, it is a fair assumption that it regards the matter as immaterial.” Uslife Credit Ins. Co. v. McAfee,
The touchstone of the materiality inquiry is whether the information in question measures the risk that the insurer assumes. Cutter & Buck,
e) Good Health Provision
Defendants further argue that Plaintiffs change in insurability and health prior to the payment of her first premium voids coverage. Defendants rely on a “good health” provision of Plaintiffs Insurance Application, which states:
“Insurance will take effect only if the certificate is issued based on this application and the first premium is paid in full while there is no change in the insurability or health of such person from that stated in the application.”
See Dkt. # 145, p. 26. Washington and Virginia courts have construed good health clauses in insurance applications as a condition precedent to recovery on the policy. See Williams v. Metropolitan Life. Ins. Co.,
As an independent ground for voiding coverage, Defendants were required to inform Plaintiff of their enforcement of the good health provision prior to litigation. As they failed to do so, they are not permitted to mend the hold and shift their grounds for rescission at this late stage. See Vision One, LLC,
0 Breach of Contract
As neither party identifies a conflict between Virginia and Washington law regarding breach of contract, the Court also analyzes this claim under Washington law. The elements of a breach of contract claim are: (1) the existence of a valid contract, (2) breach of that contract, and (3) damages resulting from the breach. See Wells Fargo Bank N.A. v. Genung,
Conclusion
For the reasons stated herein, the Court hereby finds and ORDERS that:
(1) Plaintiffs Motion for Reconsideration (Dkt. # 197) is DENIED.
(2) Plaintiffs Motion to Strike (Dkt. #201) is GRANTED. The Court STRIKES new evidence at Dkt. # 196 and accompanying text at Dkt. # 195, p. 16:15-17.
(3) Defendants’ Motion for Summary Judgment (Dkt. # 145) is DENIED as disputed issues of material fact remain as to Plaintiffs intent to deceive and the materiality of her misrepresentations as to her history of joint and musculoskeletal disorders. Defendants’ Motion is also DENIED with respect to Plaintiffs violation of her Application’s good health clause as Defendants are estopped from introducing this new basis for rescission post-litigation.
(4) Plaintiffs Motion for Partial Summary Judgment (Dkt. # 142) is DENIED as to her claim to preclude Defendants from arguing intent to deceive and DENIED as to her claim for breach of contract.
